2015 AAHA Canine and Feline Behavior
Management Guidelines
IMPLEMENTATION
TOOLKIT
Inside This Toolkit
Why Guidelines Matter.....................................................................................3
Understanding the Guidelines’ Key Points.......................................................4
2015 AAHA Canine and Feline Behavior Management Guidelines................6
Clarify Staff Roles and Responsibilities...........................................................18
Finding Qualified Trainers to Create a Treatment Team..................................20
AAHA’s Model Behavior Management Protocol............................................21
Client Tools: General Behavior Questionnaires for Dogs and Cats.................22
Resources from AAHA.....................................................................................23
AAHA Standards of Accreditation
The AAHA Standards of Accreditation include standards that
address behavior. For information on how accreditation can help
your practice provide the best care possible to your patients, visit
aaha.org/accreditation or call 800-252-2242.
Free web conference
available now!
Join Emily Levine, DVM, DACVB, for an engaging discussion
on best practices for veterinary staff to implement the
2015 AAHA Canine and Feline Behavior Management Guidelines.
Earn 1 hour of CE credit.
For more information and to register,
go to aaha.org/webconf
Why Behavior Management Guidelines Matter
Behavior is one of the major reasons Americans relinquish 3.9 million
dogs and 3. 4 million cats to shelters each year. Many of these animals
are euthanized. Therefore, helping clients cope with behavior issues and
teaching them to moderate their pet’s behavior can be a lifesaving act,
strengthening both the human-animal bond and the client’s relationship
with your practice.
All veterinary practice guidelines, like this 2015 AAHA Canine and
Feline Behavior Management Guidelines, help ensure that pets get the best
possible care. From medical director to veterinary assistant, guidelines keep
your hospital staff on the cutting edge of veterinary medicine.
The 2015 AAHA Canine and Feline Behavior Management Guidelines
offers insights, advice, and recommendations for helping you ensure that
all pets are well-trained and that they get along with family members, people outside the family, other animals, and the veterinary staff.
These AAHA guidelines review the latest information to help staff
address central issues and perform essential tasks to improve the welfare of
the pet. In addition, these guidelines define the role of each staff member, so
everyone on the team can work together to offer the highest quality of care.
Guidelines are just that—a guide—established by experts in a particular
area of veterinary medicine. Guidelines do not outweigh the veterinarian’s
clinical judgment; instead, they help veterinarians improve every pet’s quality of life.
Aligning your practice’s protocols with AAHA guidelines’ recommendations is a key step in ensuring that your practice continues to deliver the
highest quality of care.
To support your dedicated efforts, AAHA is pleased to offer this toolkit.
Here you’ll find facts, figures, highlights, tips, client questionnaires and
handouts, and other tools you can use every day to implement the recommendations of the 2015 AAHA Canine and Feline Behavior Management
Guidelines.
Thank you for helping to advance our shared mission to deliver the best
in companion animal medical care. Together, we can make a difference!
Michael T. Cavanaugh, DVM, DABVP (C/F)
AAHA Executive Director and CEO
When selecting products, veterinarians have a choice of products formulated for
humans and those developed and approved for veterinary use. Manufacturers of
veterinary-specific products spend resources to have their products reviewed and
approved by the US Food and Drug Administration (FDA) for canine and/or feline use.
These products are specifically designed and formulated for dogs and cats; they are
not human generic products. AAHA suggests that veterinary professionals make every
effort to use veterinary FDA-approved products when available and base their inventory
purchasing decisions on what product is most beneficial to the patient.
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Understand the Guidelines’ Key Points
More dogs and cats are affected by behavioral problems than any other condition, often resulting in euthanasia,
relinquishment of the pet, or chronic suffering.
Behavioral management of dogs and cats is now recognized as an essential component of primary companion
animal practice.
The most common types of canine and feline behavioral disorders are inappropriate elimination, aggression,
separation anxiety, and noise phobia.
A standardized pet behavioral assessment and discussion with the client about the animal’s behavior should be
conducted at 6 months of age and at least annually thereafter.
Relinquishment or euthanasia of dogs and cats due to behavioral problems occurs most often during the
process of social maturity at 1 to 3 years of age.
Monitoring for cognitive and physiological changes in senior pets should be conducted at least annually in
middle-aged dogs (starting at 5–8 years of age for larger breeds and 8–10 years for smaller breeds) and cats (starting at
10–12 years).
Allowing dogs and cats to have appropriate encounters with other animals, new places, and people at an early age
will minimize later occurrence of behavioral and socialization problems.
Patterns of socialization and other behaviors, both normal and abnormal, are established early in an animal’s
development; thus, correction of problem behaviors is most effective if accomplished early after onset, particularly if they
occur during puppy- or kittenhood.
Because behavioral conditions tend to be progressive, intervention at the earliest possible time will preserve quality
of life for both the pet and the client and will make the pet an easier patient to treat.
Most dogs and cats do not outgrow behavioral problems without intervention on the part of the pet owner or
the veterinary health care team.
Qualified trainers can be valuable partners on a veterinary behavior management team.
Referral to a board-certified veterinary behaviorist may be needed in intractable cases or when pet behavior
problems fall outside the capabilities of the general practice.
Treatment of pet social or behavioral problems is multifactorial and should include behavior modification, training
of alternative behaviors, and medication when appropriate.
A step-by-step case approach as defined in the guidelines should be used for diagnosis and treatment of canine and
feline behavioral disorders.
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Minimizing the patient’s fear in the veterinary hospital is critical for enabling successful examination and recovery of
hospitalized animals.
The least stressful, most humane methods of restraint should be used in the hospital, an approach that allows the
patient’s response to determine the need for and duration of pharmacologic control.
Use of behavior-modifying medications, especially on an extra-label basis, should always involve a risk-benefit
assessment and include appropriate client education.
Patient-friendly handling of canine and feline patients will enhance efficiency and quality of care in the hospital
setting and increase the client’s perception of compassionate care by the health care team.
Designating a champion is an effective approach to ensuring that behavioral management is one of the practice’s
core competencies and that the entire health care team is committed to a humane and scientific approach for managing
pet behavior problems.
Ultimately, the success of any behavior management intervention depends on a team approach that involves
appropriate veterinary team members and the pet owner in developing a treatment plan, regularly reassessing the plan,
and modifying the plan based on the patient’s response.
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2015 AAHA Canine and Feline Behavior Management Guidelines*
Marcy Hammerle, DVM, DABVP (C/F), Christine Horst, DVM, Emily Levine, DVM, DACVB, MRCVS,
Karen Overall, MA, VMD, PhD, DACVB, CAAB, Lisa Radosta, DVM, DACVB,
Marcia Rafter-Ritchie, LVT, CPDT, VTS-Behavior, Sophia Yin, DVM, MS†
To access the references (appearing as numbered footnotes) and tables
in this document, please refer to the 2015 AAHA Canine and Feline
Behavior Management Guidelines at http://tinyurl.com/p5rhddd.
Abstract
The 2015 AAHA Canine and Feline Behavior Management Guidelines were developed to provide practitioners and staff with
concise, evidence-based information to ensure that the basic behavioral needs of feline and canine patients are understood
and met in every practice. Some facility in veterinary behavioral and veterinary behavioral medicine is essential in modern
veterinary practice. More cats and dogs are affected by behavioral problems than any other condition. Behavioral problems
result in patient suffering and relinquishment and adversely affect staff morale. These guidelines use a fully inclusive
team approach to integrate basic behavioral management into everyday patient care using standardized behavioral
assessments; to create a low-fear and low-stress environment for patients, staff and owners; and to create a cooperative
relationship with owners and patients so that the best care can be delivered. The guidelines’ practical, systematic approach
allows veterinary staff to understand normal behavior and recognize and intervene in common behavioral problems early
in development. The guidelines emphasize that behavioral management is a core competency of any modern practice.
(J Am Anim Hosp Assoc 2015; 51:205–221. DOI 10.5326/JAAHA-MS-6527)
Introduction
The purpose of these guidelines is to provide practitioners and
staff with up-to-date evidence-based information to ensure that
the basic behavioral needs of canine and feline patients are met.
More dogs and cats are affected by behavioral problems than any
other condition, often resulting in euthanasia, relinquishment
of the patient, or chronic suffering. These guidelines were written to help veterinary professionals accomplish the following
objectives:1–5
1. Integrate basic behavioral management into all aspects
of clinical practice so that every patient gets the best
hands-on care in a low-stress environment.
2. Understand age-specific normal and abnormal behavior for
dogs and cats to ensure developing or existing behavioral
problems are recognized and addressed.
3. Promote routine assessment of behavioral development
and changes in behavior through the use of standardized
assessment tools.
4. Provide owners with guidance regarding the most common
canine and feline behavioral conditions so clients seek help
early (if needed).
5. Create co-operative patients and superb client-veterinarianpatient relationships so the patient and client can benefit
from a lifetime of the best possible care.
6. Impress upon the entire veterinary healthcare team the
importance of making behavioral management a core
competency of the practice.
From The Pet Doctor, O’Fallon, MO (M.H.); Mesa Veterinary Hospital, Golden, CO
(C.H.); Animal Emergency and Referral Associates, Fairfield, NJ (E.L.); University of
Pennsylvania, Biology Department, Philadelphia, PA (K.O.); Coral Springs Animal
Hospital, Coral Springs, FL (L.R.); Springville, NY (M.R.-R); and Davis, CA (S.Y.).
*These guidelines were prepared by a task force of experts convened by the
American Animal Hospital Association for the express purpose of producing
this article. They were subjected to the same external review process as all
JAAHA articles. This document is intended as a guideline only. Evidence-based
support for specific recommendations has been cited whenever possible and
appropriate. Other recommendations are based on practical clinical experience
and a consensus of expert opinion. Further research is needed to document
some of these recommendations. Because each case is different, veterinarians
must base their decisions and actions on the best available scientific evidence,
in conjunction with their own expertise, knowledge, and experience. These
guidelines were supported by a generous educational grant from CEVA Animal
Health, Virbac Animal Health, and the AAHA Foundation.
Correspondence: [email protected] (K.O.). 2015 AAHA Canine and Feline
Behavior Management Guidelines. J Am Anim Hosp Assoc 2015; 51:205–221. DOI
10.5326/JAAHA-MS-6527
AAHA, American Animal Hospital Association; BZD, benzodiazepine; MAOI,
monoamine oxidase inhibitor; SARI, dual serotonin 2A antagonist/serotonin
reuptake inhibitor; SSRI, selective serotonin reuptake inhibitor; TCA, tricyclic
antidepressant
† Deceased 28 September 2014.
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These guidelines will help readers develop the expertise and confidence to teach clients about their pets’ behavioral needs. If staff
and clients are effectively educated regarding pet behavioral needs,
veterinarians will create a healthcare team that produces the best
patient outcomes. Improved outcomes translate to increased client retention and decreased frequency of euthanasia. Veterinarians
play a pivotal role in increasing the quality of life for their patients
and for their patients’ owners. Knowledge about behavior also
reduces the risk of injury for staff and clients and improves staff
members’ job satisfaction. More efficient physical examinations,
better information exchange, and staff trained to conduct behavior modification and instructional appointments lead to improved
patient care, better case outcomes, and profitability for veterinary
practices. These guidelines will help veterinarians become clients’
first source of information so they will not seek services or advice
from those not qualified to provide optimal care.
The Importance of Client Opinion and Perception
Client perception is key in all aspects of veterinary medicine.
Veterinarians and their staff lose credibility if they are unable to
compassionately handle active, fractious, fearful, and distressed
animals. Clients are disinclined to return if their pet was fearful, if
their pet threatened/injured staff, or if the veterinarian was angry
or uncomfortable. Clients judge clinical expertise, at least in part,
on how their pet is handled and responds to the veterinarian.
Unfortunately, surveys indicate that clients typically rely on nonclinically trained individuals instead of veterinarians for advice on
pet behavior problems.6–8 These guidelines provide practitioners
with tools to help reverse that trend.
Incorporating Behavioral Assessments
into Every Examination
All veterinary visits should include a behavioral assessment. Such
assessments encourage the client to talk to the veterinarian regarding any concerns or questions they may have about their pet’s
behavior and allow the staff to better meet the behavioral needs
of their patients during and after the evaluation. Assessments
should include the use of a standardized behavioral history form
that becomes part of the patient’s permanent medical record.
Using the same questionnaire at every visit, individual behavioral
changes can be tracked and problems can be addressed early in
development.
Behavioral evaluations on record are useful after patients have
had surgery or emergency treatment. Convalescence is best evaluated with respect to the patient’s normal behaviors.
Good behavioral evaluations are especially important in young
animals. Studies show that 10% of puppies that were fearful during a physical exam at 8 wk of age were also fearful at 18 mo.9,10
Patients do not outgrow pathologic fear.
Veterinary staff should be able to recognize signs of fear and
Good behavioral evaluations are especially important
in young animals. Studies show that 10% of puppies
that were fearful during a physical exam at 8 wk of
age were also fearful at 18 mo.
distress, understand when behaviors deviate from normal, and
identify patients at risk for developing problematic behaviors.
The behavioral history will identify whether such behaviors are
exceptional and contextual (e.g., the dog is truly only afraid at
the veterinary practice) or more generalized (e.g., the cat is never
seen upstairs and must be trapped in the basement for a trip to
the veterinary practice). Such assessments help clients monitor the
patient’s behavior while educating them about risk.
Clients easily recognize trembling, shaking, and high-pitched
vocalization as signs of distress but may not recognize less overt
signs. Veterinary professionals are in an ideal position to educate clients about potential behavior problems and risk factors.
Behavioral conditions are progressive. Early intervention is essential to preserve quality of life for both the patient and client and to
provide the best chance of treatment success.
Age and Behavior
Age and life-stage patterns of behavior should be considered during behavioral and physical examinations. Normal patterns of
behavioral change are predictable as the brain matures, whereas
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atypical changes may signal the development of a behavioral problem. [Due to space considerations, this section of the guidelines
has been abridged. Please see the guidelines at http://tinyurl.com/
nj5nc5q for information about age-related patterns associated
with stage of life.]
Assembling a Support Team
Working with a Qualified Trainer
Qualified trainers can be valuable partners on a veterinary behavior management team.28 ‘‘Training’’ is an unregulated field, and
unskilled, poorly schooled trainers may cause harm. It is worthwhile to establish a collaborative relationship with a qualified,
certified, and insured pet trainer. An accomplished trainer can
work seamlessly with the veterinary team to help clients implement behavioral interventions, provide feedback, and elevate the
practice’s level of behavioral care. Diagnosis and medical intervention remain the purview of the veterinarian.
Trainers should have obtained certification from a reliable
organization that has, as its foundation, the sole use of positive
methods. Certification for trainers should require annual continuing education, liability insurance, and testable knowledgeable in
behavior and learning theory. Unfortunately, credentials don’t
guarantee the use of humane methods or honest marketing. It
is essential that clients ask trainers about specific tools and techniques used. If the tools or techniques include prong collars, shock
collars, leash/collar jerks/yanks or if the trainer explains behavior
in terms of ‘‘dominance’’ or throws anything at a dog, advise clients to switch trainers. Ensure that individuals teaching the class
do not force fearful, reactive dogs to stay in class. Forcing dogs
to remain where they are fearful, even using crates or baby gates,
worsens fear. Classes should have a high ratio of instructors to
clients and dogs.28
The Role of Technicians
Canine and feline behavior management is a certifiable veterinary technician specialty acquired through training and testing.
Veterinary Technician Specialists in Behavior and the Academy
of Veterinary Behavior Technicians understand the value of
a team approach in implementing scientifically proven and
humane behavioral treatments in clinical practice. Many technicians are interested in training and behavior and would benefit
from joining the Society of Veterinary Behavior Technicians
(www.svbt.org), a group that provides quality continuing education in this specialty.
Specialists in Veterinary Behavioral Medicine
Behavior cases can be complex, often involving public health
and safety issues. Board-certified veterinary behaviorists (diplomates of the American College of Veterinary Behaviorists, www.
dacvb.org) are specifically trained and qualified to treat clinical
behavior problems in companion animals. Referral to a veterinary
Clients easily recognize trembling, shaking, and highpitched vocalization as signs of distress but may not
recognize less overt signs.
behaviorist may be recommended in cases involving self-injury,
aggression, multiple concurrent behavioral diagnoses, profound
phobias, or for patients not responding to conventional treatment
despite the primary care veterinarian’s best efforts. Dogs either
inflicting deep bites or those injuring immunocompromised individuals should be referred to a specialist. Under no circumstances
should aggression or any condition involving a clinical diagnosis
be referred to a trainer for primary treatment. Referral to a dog
trainer is appropriate for normal but undesired behaviors (e.g.,
jumping on people), unruly behaviors (e.g., pulling on leash), and
teaching basic manners.
Changing Behaviors
Behavior Modification
Learning theory, operant conditioning, and classical Pavlovian
conditioning are mature sciences and offer a wealth of information to veterinarians. The following concepts and definitions
should help the healthcare team incorporate basic learning theory
and behavior modification into clinical practice and to recognize
and make recommendations against inappropriate, unkind, and
dangerous behavior correction practices often recommended by
nonprofessionals. Avoidance and safety are the cornerstones of
behavioral treatment. Comprehensive behavior treatment plans
include medication, behavior modification/training, and environmental change/management. Commonly accepted principles of
behavior treatment and modification are as follows:29
yy When behaviors are rewarded, they are repeated and
increase in frequency.
yy New behaviors are learned best if they are rewarded each
time they occur.
yy After a behavior has been acquired, it is best maintained if
it is rewarded randomly and intermittently, which is more
often than ‘‘seldom.’’
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yy Dogs and cats will repeat a learned behavior if it is
rewarded and will exhibit behaviors their owners desire if
those behaviors are rewarded.
Behavior modification is often described using the following
terminology:
yy Positive: something is given to the animal (e.g., a reward is
positive reinforcement given for desired behavior).
yy Negative: something is taken away from the animal (e.g.,
attention is withheld from a dog as negative reinforcement
for an undesirable behavior, not petting a jumping dog).
yy Reinforcement: a consequence that increases the likelihood
of the behavior in the future.
yy Punishment: a consequence that decreases the likelihood of
the behavior in the future.
The term ‘‘behavior modification’’ refers to techniques that
either increase or decrease the frequency and expression of behaviors. The basic techniques discussed here are part of an integrated
approach to treating problem behaviors:
yy Desensitization: the process by which a stimulus associated
with an undesirable behavior is presented to the individual
at a level below that which elicits the response followed by
a gradual increase in the stimulus level. If desensitization
is properly done, individuals do not become aroused
following exposure to the stimulus.
yy Counterconditioning: a process in which an animal that is
reactive, fearful, or aggressive to a specific stimulus (e.g.,
the doorbell, an approaching dog) learns to become happy
and accepting of that stimulus. This is accomplished by
pairing the stimulus with something that the dog or cat
likes and wants. Counterconditioning and desensitization
are often combined so that rewards are given when a dog
or cat does not react to a stimulus to which they previously
reacted, even when the stimulus gradually increases. For
example, if a dog is fearful of a vacuum cleaner, gradual
exposure to the vacuum cleaner is paired with something
the animal likes and on which the dog can focus (e.g.,
highly desirable food), enabling the dog to associate the
vacuum cleaner with something good. This technique is
not the same as flooding, which should be avoided.
yy Flooding: prolonged exposure to the worrisome stimulus
at a level that causes the anxious, aggressive, or fearful
response in the hope that simply by presenting the
stimulus continuously, the undesirable behavior will stop.
Unlike desensitization (where the goal is to expose the dog
or cat to a worrisome stimulus at a level below that which
will trigger the response), flooding exposes the animal to
the stimulus at a level that triggers the response. In the
case of distressed patients, flooding actually sensitizes
the patient to the stimulus and worsens it by causing
shutdown or collapse of a patient. Dogs and cats repeatedly
exposed to inescapable unpleasant or painful stimuli may
develop learned helplessness, that is, they cease offering
any behaviors because they learn they have no control over
outcomes. Flooding is never recommended.
yy Training an alternate behavior: a process in which an
appropriate behavior that is incompatible with the problem
behavior is taught as an alternate response using positive
reinforcement. For example, if a cat habitually chases a
person’s feet, the cat is taught to go to a high perch for a
treat in response to a cue, in this case the appearance of a
human being. The cue indicates that a treat will be given if
the cat goes to the perch when someone enters the room.
yy Distraction and redirection: a process in which food or
another reward is used to lure the individual’s attention
away from a stimulus to preempt a response, decreasing
fear or aggression. For example, a cat that habitually chases
a person’s feet is distracted (redirected) when a toy is waved
in its face so the cat plays with the toy instead of focusing
on the person’s feet.
yy Environmental enrichment: the addition of one or more
external factors in order to reduce the frequency of
abnormal or unwanted behaviors while increasing the
frequency of normal, desired behaviors. For example, if
a dog that paces when left alone is provided with a food
toy, the dog will work with the toy rather than pace. Many
dogs with behavioral problems are too distressed for simple
Referral to a veterinary behaviorist may be
recommended in cases involving self-injury,
aggression, multiple concurrent behavioral
diagnoses, profound phobias, or for patients not
responding to conventional treatment despite the
primary care veterinarian’s best efforts.
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environmental enrichment alone to have an effect.
yy Avoidance: the act of preventing an individual from
engaging in unwanted behaviors. This technique protects
distressed dogs and cats from exposure to adverse
behavioral stimuli that will make them worse. Protection
is the first treatment step. For example, a dog barks at
people seen outside the window. Closing the blinds or
sequestering the dog at the back of the house avoids the
stimulus that triggers the barking response.
Aversive Techniques
This Task Force opposes training methods that use aversive techniques. Aversive training has been associated with detrimental
effects on the human-animal bond, problem-solving ability, and
the physical and behavioral health of the patient.29–32 It causes
problem behaviors in normal animals and hastens progression of
behavioral disorders in distressed animals.33 Aversive techniques
are especially injurious to fearful and aggressive patients and often
suppress signals of impending aggression, rendering any aggressive
dog more dangerous.34–36
Aversive techniques include prong (pinch) or choke collars,
cattle prods, alpha rolls, dominance downs, electronic shock collars, lunge whips, starving or withholding food, entrapment, and
beating. None of those tools and methods should be used to either
teach or alter behavior. Nonaversive techniques rely on the identification and reward of desirable behaviors and on the appropriate
use of head collars, harnesses, toys, remote treat devices, wraps,
and other force-free methods of restraint. This Task Force strongly
endorses techniques that focus on rewarding correct behaviors and
removing rewards for unwanted behaviors.
Pharmacological Intervention
Medications commonly used to treat behavioral conditions in
dogs and cats include the following:
yy Benzodiazepines (BZDs): alprazolam, diazepam,
midazolam, clonazepam, and related medications like
gabapentin.
yy Tricyclic antidepressants (TCAs): amitriptyline,
nortriptyline, clomipramine, imipramine, and doxepin.
yy Selective serotonin reuptake inhibitors (SSRIs): fluoxetine,
paroxetine, sertraline, fluvoxamine, citalopram, and
escitalopram.
yy Dual serotonin norepinephrine reuptake inhibitors:
venlafaxine and duloxetine.
yy Dual serotonin 2A antagonist/serotonin reuptake
inhibitors (SARIs): trazadone and nefazodone.
yy Monoamine oxidase inhibitors (MAOIs): selegiline.
yy Azapirones: buspirone.
yy Centrally acting 2A agonists that may act as hypotensives
Problems involving pathological behaviors,
including aggression, are never cured but can be
treated and managed. Failure to do so may lead to
euthanasia of the animal.
(decrease in cardiac output and peripheral vascular
resistance): clonidine, guanfacine, medetomidine, and
dexmedetomidine.
yy Local anesthetics (such as lidocaine gel): used before
venipuncture, vaccination, or anal sac expression,
especially in patients that have experienced procedurerelated fear or pain.
Of those medications, only clomipraminea and fluoxetine (for
canine separation anxiety) and selegilineb (for canine cognitive
dysfunction syndrome) are approved for dogs in the United States.
Controlled studies have demonstrated the efficacy of clomipramine and fluoxetine in combination with behavior modification
for treating separation anxiety.38–44 Because there are few controlled
studies for other medications or indications, most medications are
used on an extra-label basis. Extra-label use of pharmaceuticals
must be done in the context of diagnosis, a comprehensive treatment plan, a discussion of mechanism of action and expected
changes, and full disclosure that use is nonapproved.
Some medications can be used as needed (e.g., BZDs, 2A
agonists, some SARIs, gabapentin) for fears, phobias, and panic.
Daily medications may also include TCAs, SSRIs, SARIs, BZDs,
2A agonists, and gabapentin for general fears and anxieties. Onset
of action may depend on biotransformation and subsequent
regional brain molecular receptor changes; therefore, treatment
effects for some medications may not appear for 5–8 wk. Dosage
recommendations are available elsewhere.14 Keep in mind that
when combining medications, dosages may change, and interactions may occur.
Medications should be used only as part of an integrated
treatment program. The goals of that approach are to protect
the patient and their owners, provide a suitable environment for
improvement, and implement appropriate behavior modification,
including use of humane, positive reinforcement tools.
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Risk assessment is essential for medication use. For example,
BZDs can have occasional side effects that render some animals
extraordinarily sedated and at risk for self-trauma. Other animals are extraordinarily aroused and also at risk for self-injury.
It is impossible to know if a particular animal will experience
undesirable effects in advance; therefore, a team approach to treatment, observation, reporting, and recording outcome is essential.
Veterinarian and client monitoring should include observation of
heart rate, agitation or sedation, profound changes in appetite,
vomiting, diarrhea that is not transient, and any new problematic
behaviors or behavior changes.
Nutraceuticals and specialized diets are available that may or
may not aid in the treatment of behavior problems. Research on
nutraceuticals is ongoing and usage recommendations are not
evidence-based at this time.
This Task Force recognizes that there are many alternative
therapies used for behavioral problems. As a general rule, such
treatments have not been adequately studied to warrant specific
recommendations by the Task Force on either their use or benefit at this time. For example, although pheromonal products are
commonly used to alter canine and feline behavior, there is no
consensus among experts regarding their value, and definitive
clinical study evidence of their efficacy is lacking.
Common Behavioral Problems
Aggression
Aggression occurs any time an animal growls, snarls, snaps, or bites.
Fear is one of the most common causes of aggression. Punishment
should not be used in aggression cases because it increases the
risk of bites and aggravates aggressive behavior. Treatment of the
underlying cause is key. That approach usually involves avoidance,
protection (of the dog and humans), behavior modification, extralabel medication use [TCAs, SSRIs, and sometimes gabapentin or
certain BZDs (e.g., alprazolam)], and various restraint tools such
as head collars and harnesses. Management of unwanted aggression may be lifelong.
Use of a liability release form containing the following disclaimers is recommended in the treatment of aggression:
yy Any animal that is aggressive for any reason has the
potential to cause serious damage and harm to itself and
other pets and people.
yy Special precautions must be taken to ensure that everyone
is safe when interacting with aggressive dogs. These
precautions may include some form of confinement (e.g.,
gates, crates) or the use of leads, harnesses, head collars,
and muzzles.
yy Proof of current rabies vaccination should be provided to
anyone involved in the treatment of the aggression.
yy Treating a behavioral aggression problem is not a substitute
for adherence to local laws.
yy Owning an aggressive dog or cat carries with it
responsibility and potential liability for any damage done
to people or property. This responsibility is not changed or
transferred by seeking behavioral help.
yy Problems involving pathological behaviors, including
aggression, are never cured but can be treated and
managed. Failure to do so may lead to euthanasia of the
animal.
Elimination Disorders
Elimination disorders in cats are typified by elimination outside
of a preferred area. Diagnostic indicators include urine marking
(which can also be a normal behavior) and toileting outside of the
litter box. Prior to implementing behavioral treatment, treatment
of any underlying medical conditions that may be contributing to
the problem is essential.
Environmental changes are the first line of treatment and are
often effective. Examples include providing extra litter boxes,
cleaning litter boxes more often, and changing litter type/litter
box style to improve access.45 Behavioral treatments can also have
positive effects on animals treated for primary medical disorders
because medical and behavioral conditions can exist concurrently
and exacerbate each other.
Separation Anxiety
Separation anxiety can occur when a pet is either left home alone
or separated from its owner. Separation anxiety usually presents
as signs of clinical distress such as pacing, panting, vocalizing,
urination, destruction of property, and salivation. This condition
should be considered to be a behavioral emergency. Medications,
including clomipramine and fluoxetine, have both been approved
for use in dogs and should be used as a first-line treatment at the
earliest sign of clinical distress. A comprehensive treatment plan
includes behavior modification, environmental enrichment, and
minimizing separation to the extent possible. Signs of separation anxiety may not be apparent to the owner. This Task Force
encourages all clients to annually videotape their pet when they
are not home as a way to detect behavioral abnormalities, including less obvious forms of separation anxiety. Medications have a
higher likelihood of treatment success if they are used early in the
development of observed anxiety. Duration of treatment depends
on severity of the anxiety and response to treatment.
Noise Phobia
Noise phobia during thunder, fireworks, or storms is a profound
fear manifested by hiding, trembling, destruction of property, salivation, or panting. Those behaviors occur in response to a specific
sound or circumstances associated with that sound. Anxiolytic
medications (e.g., alprazolam and clonazepam for dogs and oxazepam for cats) are used on an as-needed basis as the first line of
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treatment and should be given 1–2 hr before an anticipated triggering event.14 Some patients may also need daily medication, and
everyone should have concurrent nonpharmacologic management
for long-term treatment.46 Other anxiety diagnoses often coexist
with noise phobia. Screening for potential comorbidities is important because comorbidity worsens each condition.15
Cat-to-Cat Aggression
Cat-to-cat aggression is evidenced by behaviors such as staring,
hissing, swatting, scratching, growling, or biting other cats in the
home environment. Treatment plans include medication (generally
start with fluoxetine), environmental enrichment, training, play
therapy, and safety tools. Regardless of the underlying cause for
inter-cat aggression, a critical step in treatment involves separating
the cats until a course of medication and behavior modification
has been completed. The cats may then be gradually reintroduced.
Cases of aggression within a cat’s social group can take anywhere from 2 to 12 mo to resolve, requiring patience. Permanent
separation of cats is always an option.
Using a Case Approach
All veterinary personnel should be able to use standardized behavior assessment tools and provide general guidance on managing
canine and feline behavioral problems. A recommended case
approach includes the following steps:
1.Identify a behavioral problem during a preventive care
appointment after the client either completes a brief
screening questionnaire or requests help for a specific
behavioral concern.
2.Monitor the patient’s stress level as it enters the hospital
and is moved to the exam room (see the section,
‘‘Minimizing the Patient’s Fear in the Veterinary Clinic’’).
3.Provide client-education materials about common
behavioral disorders, their prevention, and treatment.
4.While the patient is in the exam room, review the
behavioral history by asking general questions, such as the
age of onset and progression of any behavioral problems
and situations that trigger the problem behaviors. A risk
assessment should be made, including the likelihood of
injury to the pet and human handlers and any risk of
relinquishment of the pet.
5.Complete a comprehensive physical exam, including
diagnostic testing.
6.Make a list of problem behaviors and a presumptive
diagnosis based on specific behavioral descriptions (e.g., a
dog bites a child only in the presence of food).
7.Develop a management plan designed to reduce stress in
any clinical situation.
8.Make a list of differential diagnoses based on the current
literature and the existence of possible comorbidities.
9.Advise clients to implement the first treatment step,
avoidance and protection, immediately. For example, when
a child is near food, restrict the dog’s access to the child.
Conversely, restrict the child’s access to the dog when the
dog is eating. That strategy avoids the manifestation of
problem behavior and protects both the dog and child.
10.Make a final diagnosis based on the overall analysis,
consultations with veterinary behavior specialists, and
reference materials.
11.Devise a written treatment plan based on best practices.
12.Follow up with the owner by phone or text.
13.Schedule regular rechecks.
Minimizing the Patient’s Fear in the Veterinary Clinic
Adverse Effects of a Stress Response
One study reported that 106 out of 135 canine patients (78.5%)
were fearful on the examination table.47 Eighteen of the dogs
(13.3%) had to be either dragged or carried into the practice, and
<50% of the dogs entered the practice calmly. Dogs <2 yr, a patient
population that is presented to veterinary hospitals relatively
often, were more fearful than older dogs that see veterinarians less
frequently, suggesting that recent exposure to the hospital environment on a repeated basis may increase fear. Hernander (2008)
noted that dogs that had recently visited the veterinary hospital
had higher stress levels than those that had not.48 Dogs that had
some control over their examination were less stressed, and dogs
that had had only positive experiences were less fearful than others, suggesting that dogs learn from interacting with empathetic
veterinary personnel.47
Cases of aggression within a cat’s social group can
take anywhere from 2 to 12 mo to resolve, requiring
patience.
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that are not calm. Clients can videotape their interaction with
the dog to identify behaviors they should ignore and those
that should be rewarded.
Data Collection, Follow Up,
and Further Recommendations
Request that videotapes be taken over a 7 day period when the
dog is left alone and submitted for assessment. Schedule an
appointment 2 wk later to start active behavior modification.
Appointment 2: Treatment Plan
SAMPLE CASE: Canine
Separation Anxiety
Appointment 1: Treatment Plan
Avoidance
Avoid leaving the dog alone or loose in the home. Determine
if the dog can safely be crated by questioning the client
and/or videotaping the dog entering a crate and remaining
inside when the owner is absent. If the dog panics in the
crate or resists entering the crate (e.g., freezes, destroys the
crate, or injures itself ) consider pet sitters, home day care,
or boarding in the hospital so the dog can be observed and
protected. Encourage clients to be calm during departures
and either avoid or minimize cues associated with departurebased distress.
Pharmacology
Start medications that act quickly (e.g., BZDs, SARIs, 2A
agonists) immediately after the baseline behavioral
assessment. If necessary, dosages can be adjusted once lab
results are available. Conduct laboratory evaluation [complete
blood cell count, serum biochemical analysis, thyroid testing
(thyroxine, free thyroxine), and urinalysis] to rule out any
medical complications before starting long-term medications
(i.e., TCAs, SSRIs). Arrange for a stable care situation for the
dog for a period of at least 5 days while starting long-term
medications and monitoring for adverse effects.
Management
Minimize absences from the dog. Have the owner offer the
dog food toys when at home. If the dog uses them, offer those
types of toys when the dog is alone. If the dog is able to eat
the food obtained from the toy it is a sign that dog’s anxiety is
lessening. Dogs that are extremely distressed cannot eat.
Behavior Modification
Encourage the client to practice passive behavior modification
by praising the dog for calm behavior and ignoring behaviors
Avoidance
Assess the client’s ability to avoid triggering the distress
response in the dog.
Pharmacology
Question the client about subjective changes in behaviors
the dog is exhibiting and objective changes (i.e., frequency,
duration or intensity of problem behaviors, any change
observed) since the last visit. Assess whether any behavioral
changes should be treated with additional medications. For
example, is panic a component of the problem? If yes, then a
panicolytic medication (alprazolam) should be suggested.
Management
Decide whether food toys are helpful and what safe
containment tactics are needed.
Behavior Modification
Teach the dog to relax using positive reinforcement steps
(e.g., sit and look commands, offering a treat) in preparation
for active behavior modification, including desensitization
and counterconditioning to aspects of being left alone. Have
the client keep a log of the dog’s behaviors. As soon as the
dog has acquired calm learned behaviors, a qualified person
can then coach the clients and dog through desensitization
and counterconditioning using a stepwise program. Ask
the client to provide short videos every few days so that
the healthcare team can determine if the behavioral
modification is progressing satisfactorily. Client videos also
provide an excellent source of continuing education for
veterinary personnel.
Data Collection, Follow Up,
and Further Recommendations
Rechecks performed by veterinary medical staff should occur
q 2–4 wk until the dog’s behavior is stable and q 3–6 mo
thereafter. Electronic follow up using videotapes and behavior
logs is helpful.
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that require complete physical immobilization; ‘‘scruffing’’ cats that show no
signs of arousal; ‘‘stretching’’ cats that
may do better wrapped; and pinning
dogs against walls or between gates,
in runs, or fences for injections. All of
those techniques make calm animals
fearful and make fearful animals worse,
less reliable in terms of safety, and
less able to be calmly examined in the
future. For humane, low-stress exams,
less is truly more.
Benefits of Low-Stress Handling
Veterinarians who understand that the
examination experience can be stressful for their patients and who instead
emphasize low-stress handling will
increase their credibility with clients.
Using behavior-centered patient hanVeterinarians who understand that the examination experience can be
dling techniques will enhance efficiency,
stressful for their patients and who instead emphasize low-stress handling
increase client perception of compassion, increase client retention, and
will increase their credibility with clients.
vastly improve the quality of patient
care. Calmer patients pose fewer risks to
Fear and stress also affect hospitalized patients. Postoperative
themselves and human handlers. A less stressful workplace envipatients that were not fearful and stressed had fewer physiological
ronment is best for everyone. Reducing fear in veterinary patients
indicators of stress, experienced fewer nosocomial infections, had
requires that the practice leadership make this behavior-approach
49
faster rates of recovery, and required fewer postoperative visits.
a priority. The most progressive staff in the world cannot effect
Patients that underwent anesthesia were anecdotally often reported
change if the leadership does not support it.
to later be more fearful or reactive, suggesting that postoperative
distress behaviors may warrant medication and behavioral intervenTips for Reducing Patient Fear in the Veterinary Clinic
tion to calm the patient. Those findings have profound implications
1.Reduce stress by having separate waiting areas for dogs and
for how hospitalized patients are cared for. Compliance and frecats with separate air-handling systems, if possible.
quency of exams decline when clients believe that the inevitable
2.Ensure that all dogs can have at least 1– 1.5 body lengths
result of a visit to the veterinarian is anxiety in their pets.48,50
between themselves and other dogs. Barriers can help keep
Manual restraint and forceful handling of animals in the vetanimals separated.
erinary hospital may interfere with successful case outcome. A
3.Invest in nonslip floors that are back friendly and provide
heavy-handed approach can affect the ability to obtain accurate
secure footing for dogs and cats.
physical and laboratory data and may increase levels of physi4.Create a protocol for reactive patients. That may include
ological stress. Manual restraint also increases the likelihood of
either calling or texting clients when they can walk
struggle and risk of injury to staff and patients.16,51,52 The physidirectly to the exam room, having the veterinarian already
ological after-effects of physical restraint can lessen the efficacy
in the exam room, using a blind or bringing a reactive
of subsequently administered sedatives or other forms of chemidog into the hospital through either a side or back door.
cal restraint. This Task Force recommends that the least stressful,
Reactive dogs may do best as the first or last patient of
most humane methods of restraint be used first, an approach
the day. They generally do worse in a busy practice where
that allows the patient’s response to treatment and handling
appointment delays are common. Giving preanesthetic
determine the degree and duration of pharmacologic intervenmedication with the client present may facilitate care.
tion. Examples of inappropriate physical restraint include nail
5.Move at the animal’s pace. Rushing may cause delays or
trims that require several people to hold the animal; blood draws
intractability at a later visit.
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6.Teach staff to use standardized questionnaires to evaluate
stress at the hospital and invest in ensuring that everyone
can accurately read canine and feline normal and stressrelated behaviors and body language.
Handling Anxious or Reactive Patients
The following items are suitable for creating a less stressful hospital environment for canine patients:
yy Nonskid mats, rubber shelf liners, or yoga mats on
horizontal surfaces.
xx Blue is a preferred color because it can be readily seen
by dogs.
xx Dogs have greater control and feel safe from falling
when they stand on nonslip mats, which also warm the
exam table.
yy Towels for wraps and bolsters. Clean towel wraps provide
safe containment of limbs and heads.53 They are easy to
use, not offensive to owners, provide better control and
surface area coverage without human contact, and may
induce a sense of security and muscle relaxation.
yy If the occasional patient finds being wrapped in a towel
stressful, simply do not use the wrap.
xx Practice using towels and wraps on calm animals before
attempting them on distressed patients.
yy Treats.
xx Treats can include fish flavored snacks (e.g., dried/tinned
shrimp/anchovies), flavored hair ball preparations, yeast
spreads, cream cheese, cheese spreads, and shredded
cooked chicken. Treats must be palatable, have an
olfactory component at room temperature, and be small
enough so that dogs and cats can have several without
appreciable caloric intake.
xx Treats can be used for distraction, redirection,
counterconditioning, and reward techniques.
xx Caution is urged for patients/handlers with food allergies
(e.g., peanut butter) and for dogs that become more
aggressive in the presence of any food.
yy Toys.
xx Toys can be used for distraction, redirection,
counterconditioning, and lowering a patient’s fear
and stress.
xx Toys should either be kept clean and washed between
patients or sent home with the patient.
yy Basket muzzles.
xx Well-fitted basket muzzles prevent bites to staff and
clients that handle anxious animals. Other forms of
muzzles may not prevent bites.
xx Staff members may be less fearful and use less restraint
if a difficult patient is muzzled and is accustomed to
the muzzle.
xx Basket muzzles pose less of a health risk for dogs compared
with nonbasket muzzles (e.g., vomiting), can be put on
easily, and allow dogs to accept treats and drink.
xx To minimize risk, dogs must be taught to voluntarily put
their face into the muzzle using reward-based training.
xx Muzzles can become weapons that cause injury to
humans and other animals if the muzzled dog is
distressed. Cautious, calm handling still applies to
muzzled dogs.
xx For the safety of the staff and the patient, all fractious
animals under chemical restraint or sedation should wear
a well-fitted basket muzzle throughout the procedure if
not medically contraindicated.
yy Remote controlled treat dispensers.
xx Treat dispensers can be used with techniques involving
distraction, redirection, and counterconditioning and
can lower fear and stress.
xx Treat dispensers located some distance from personnel
will direct the dog’s attention away from handlers.
xx Dogs that are aggressive in the presence of food/treats
may either guard dispensing devices or become aggressive
in their presence.
xx Some treat dispensers may require a specific type of treat
that may not be palatable to all dogs.
yy Spreadable treats and squeezable food.
xx Spreadable treats (e.g., cream cheese, spray cheeses, pâtés,
yeast spreads, some tinned foods) can be delivered at a
distance rather than by hand.
xx A treat can be placed on tables, walkways, long spoons,
toys with long handles, or pizza boards, encouraging the
Clean towel wraps provide safe containment of limbs
and heads.
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dog to move away from handler to get the treat.
xx Treats can be distributed over a large area, creating a
wide area of focus and interest for the patient.
xx Spreadable treats can be used in distraction, redirection,
counterconditioning, and to reduce fear and stress.
xx Spreadable treats and squeezable foods should not be used
with dogs that become reactive or aggressive around food.
xx When food treats are used, veterinary personnel and
clients should be screened or cautioned about possible
food allergies.
yy Head collars and halters.
xx Head collars and halters provide better control than
standard collars, allowing the handler to turn the dog’s
head or close its mouth without force.
xx Head collars and halters should be well fitted.
xx Dogs must become accustomed to these devices.
xx Immediately stop using a head collar or halter if the dog
feels trapped or panics.
xx Because of the risk of injury or strangulation, leads,
collars, head collars, harnesses, and halters should not be
left on unsupervised dogs.
The following equipment is useful for minimizing in-clinic
stress for feline patients:
yy Cat squeeze boxes and cat bags.53
xx Intramuscular sedation of fractious cats is an ideal use for
a cat squeeze box.
xx Squeeze boxes may have a calming effect on a cat.
xx The squeeze box allows for the application of less
restraint and is best used by a skilled handler.
xx Some cats may become anxious or freeze when their
movement is restricted; therefore, the use of squeeze
boxes or cat bags are not suitable for such cats.
xx Injury to the handler or cat is still possible with cat bags.
yy Box basket or carrier for cats to hide in.
xx Cats hide as a normal coping behavior in response to a
stressful situation.
xx Providing feline patients with a box, basket, or carrier as
a place to hide has a calming effect for many cats.
Medications for Fearful Dogs and Cats
Anxiolytic medications or sedatives can make veterinary visits less
stressful for canine and feline patients. Some medications can also
provide chemical restraint when needed. The following medications are suitable for administration by the owner the day before
and the day of the exam: BZDs (e.g., alprazolam, midazolam,
lorazepam), gabapentin, SARIs (e.g., trazodone), and clonidine.
All of those medications can be used with dexmedetomidinec (a
2A-agonist class sedative) and antipamezoled (a 2A-antagonist
reversal agent). All of those medications can be given q 12–24 hr
or as needed for veterinary visits.
BZD dosing is highly individualized, and trial and error is
needed to find the best dose for each patient. BZDs are given 1–2
hr before the exam and repeated 30 min before the exam. Whole
or half-dose increments can be given to achieve optimal dosages.
Most BZDs are scored and easily cut. For patients that do not take
tablets well, BZDs can be made into a paste with a small amount
of liquid and immediately smeared on the gums or tongue. As soon
as the patient licks or swallows, the medication enters the system.
Maropitant citratee is approved for use in dogs and may quell
nausea associated with travel to a veterinary exam. Maropitant
citrate in a weight-adjusted dose can be given in tablet form 1–2
hr before an appointment. For mild sedation of cats, oral chlorpheniramine given q 12–24 hr or phenobarbital given 1 hr prior
to travel (and repeated during travel if needed) are appropriate
medications. Recommended canine and feline dosages for medications are described in detail elsewhere.14
The time to prevent difficulties in administering medication
is when the patient is a puppy or kitten. All patients should be
taught at an early age to take pills or liquid medications in real or
placebo form.
Establishing Behavior Management as a Core Competency
Providing feline patients with a box, basket, or
carrier as a place to hide has a calming effect for
many cats.
Companion animal practices that develop behavior management as a
core competency have taken an important step toward ensuring that
their patients maintain a safe, happy relationship with their owners
and live in a low-stress environment. For that effort to succeed, the
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rescue or breed animals should be specifically counseled about the
importance of exposure and handling in the first 2 mo of life.
Clients should be advised that brain and behavioral development
occurs the fastest between 5 and 24 wk and that animals are not
socially mature until at least 1–1.5 yr. During that 18 mo period,
the practice team must act as an educational resource for the behavioral care of puppies and kittens. Because behavioral medicine is a
rapidly developing field, numerous educational opportunities are
available to all team members in this important practice specialty.
When behavior management is a core competency,
the practice will value a culture of kindness toward
its patients and empathy with its clients.
entire healthcare team must be committed to a scientific approach
to assessing behavior and diagnosing/treating behavior problems. It
is helpful to identify a champion in the practice to lead this effort,
but there must be a commitment from the practice leadership to
support the implementation of humane handling techniques and
preventive and interventional behavioral medicine.
That effort requires a commitment to staff education. Every
member of the healthcare team, including kennel workers, must
be adept in reading basic animal body language and be able to
spot at-risk behaviors that signal stress, fear, aggression, or withdrawal. All staff members should be knowledgeable about humane
handling techniques and types of restraint and understand that
restraint is a procedure in itself, not just the means to a procedure.
Using that approach will mean manual restraint will be used less
often and only when necessary.
When behavior management is a core competency, the practice
will value a culture of kindness toward its patients and empathy
with its clients. An evidence-based approach to pet behavior management is an investment in a long-term veterinarian-pet-client
relationship that focuses on case outcomes rather than expediency.
Humane, gentle-handling techniques help ensure that patients
will experience minimal stress during an exam visit and will be
manageable during the next visit.
Primary care veterinarians should not hesitate to seek specialized animal behavior expertise outside their practices when
necessary. Veterinary behavioral medicine is a specialty requiring
training, testing, and certification. Referring clients to a qualified
veterinary behavior specialist extends the primary care practice’s
services to ensure the well-being of their patients.
All team members should be committed to a program of
‘‘behavior prophylaxis’’ whereby puppies and kittens are treated
in a nonthreatening manner from their first visit. As part of that
approach, team members should educate all clients about normal
and abnormal pet behavior and the importance of avoiding situations that create behavioral health problems. Clients that either
Conclusion
Behavioral abnormalities in dogs and cats include anxiety, stress,
depression, aggression, and inappropriate elimination. Behavioral
problems affect more dogs and cats than any other medical
condition and are one of the most common causes of euthanasia, relinquishment, or abandonment of pets. For that reason,
behavioral management of dogs and cats is now recognized as an
essential component of primary companion animal practice. Each
healthcare exam should include an evaluation of the pet’s behavior. A basic tenet of behavioral management is that patterns of
social and other behaviors, both normal and abnormal, are established early in development. Correction of problem behaviors is
most effective if accomplished soon after onset, particularly if they
occur during puppy or kittenhood.
Treatment of social or behavioral problems is multi-factorial.
Behavior can be modified by proven techniques that can be implemented by the owner with veterinary guidance. The primary role
of pharmacologic intervention in pet behavior management is to
reduce anxiety and to enable patient-friendly physical handling in
the clinical setting.
Practices that want to establish behavioral management as
a core competency should involve each member of the healthcare team in a comprehensive approach to problematic behavior
recognition, assessment, correction, and counseling. Extreme
or intractable behavior problems in pet dogs and cats may fall
outside the capabilities of even an experienced primary care veterinarian; therefore, referral to a veterinary behavior specialist is an
important and viable option.
By developing expertise in pet behavioral management across
the entire healthcare team, veterinary practices provide an added
dimension of value that increases the quality of life for its patients
and clients and reinforces the pet-veterinarian-client relationship
for the lifetime of the patient. 
Footnotes
a. Clomicalm; Novartis Animal Health US, Inc., Greensboro, NC
b. Anipryl; Zoetis, Inc., Florham Park, NJ
c. Dexdomitor; Zoetis, Inc., Florham Park, NJ
d. Antisedan; Zoetis, Inc., Florham Park, NJ
e. Cerenia; Zoetis, Inc., Florham Park, NJ
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Clarify Staff Roles and Responsibilities
Veterinarian
Technician
yy Assess every patient regardless of appointment type
(wellness, acute care, follow-up visits) for normal
(that is, age and life-stage appropriate) behavior and
behavioral problems
yy Develop behavior management standard operating
procedures (SOPs), including procedures for
•• Using standardized behavior assessment tools
•• Obtaining patient histories that include
assessment of behavior problems
•• Conducting client education on appropriate
and problem behavior in pets and intervention
strategies for treating problem behaviors
•• Implementing patient-friendly handling
techniques in the hospital setting to minimize
stress during examinations and hospitalization
•• Using chemical restraint to facilitate examination
and treatment
yy Implement the practice’s model behavior
management protocol
yy Develop a network of qualified pet trainers and
animal behaviorists for case referral
yy Provide staff education on
•• Effective client communication and education
about pet behavior problems
•• Normal canine and feline behavior for the animal’s
age and life stage
•• Recognition and assessment of canine and feline
behavior problems
•• Pharmacologic intervention for treatment of
behavior problems and in-hospital restraint
yy Obtain patient’s medical and medication history,
including indicators and potential sources of problem
behavior
yy Anticipate procedures or situations that can contribute to
anxiety or aggression
yy Use patient-friendly and stress-relieving techniques
during examinations or with hospitalized patients
yy Recognize signs of problem behaviors
yy Administer medications and other treatments as directed
by the veterinarian
yy Observe interaction among patients and their owners that
may indicate or contribute to behavior problems
yy Maintain effective client education and follow-up,
including verbal and written instructions
Reception and other
client-service personnel
yy Watch for indicators of problem behavior in canine and
feline patients
yy Schedule follow-up appointments to monitor behavior
management interventions
yy Contact clients after the office visit to respond to
questions and concerns
yy Refer questions to clinical staff as appropriate
yy Remind clients that they are part of a team approach to
behavior management, requiring their understanding,
compliance, and feedback
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19
Finding Qualified Trainers to Create a Treatment Team
Qualified trainers can be valuable partners of your veterinary behavior team. That said, “training” is an unregulated field, and
unskilled, poorly schooled trainers may cause harm. It is worth the effort to establish an ongoing collaborative relationship with an
excellent, educated, certified, insured trainer.
While diagnosis and medical intervention remains the purview of the veterinarian, an excellent trainer can seamlessly help clients
implement interventions and work with the veterinary team to provide feedback, key information, and the highest quality of care.
Trainers should have a certification in dog training from a reliable organization that has, as its foundation, the sole use of positive
methods. Certification for trainers should require annual continuing education (CE),
liability insurance, and testable knowledgeable in behavior and learning theory.
For groups that meet this standard see:
Certification Council for Professional Dog Trainers (CCPDT), www.ccpdt.org
International Association of Animal Behavior Consultants, www.iaabc.org
Karen Pryor Academy (KPA), www.karenpryoracademy.com/dog-trainer-program
Peaceable Paws Academies, www.peaceablepaws.com
Pet Professional Guild (PPG), www.petprofessionalguild.com
You should be able to observe classes
and the techniques and style used
for your patients. Classes should
have a reasonable ratio of instructors
to clients/dogs. For some helpful
guidelines see:
http://avsabonline.org/uploads/
position_statements/How_to_
Choose_a_Trainer_%28AVSAB%29.pdf .
Many cases require the help of behavior
specialists, and all veterinarians and
trainers should become familiar with
board-certified veterinary behaviorists
(www.dacvb.org) in their area.
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AAHA’s Model Behavior Management Protocol
Step
Procedure
Responsibility
Obtain patient’s history
yy Observe arriving patient for level of anxiety and tractability
yy Have the client complete a standardized behavioral assessment tool
yy Inquire about problem behaviors (change in normal behavior, development of new
behaviors, inappropriate elimination, aggression, separation anxiety, noise or other phobias)
yy Determine complete medication (include nutritional supplements) and diet history
yy Update patient’s medical history records
Reception personnel
(initial patient observation;
provide client with behavioral
assessment tool)
2
Physical examination
yy Evaluate results of standardized behavioral assessment tool
yy Observe patient without interaction
yy Observe patient response to handling and palpation
yy Administer pharmacologic restraint as needed for examination or diagnostic evaluation
yy Perform complete physical for physiologic indicators of behavioral abnormalities
yy Perform diagnostic testing as indicated by patient history or physical examination
Veterinarian
3
Diagnosis of behavioral abnormalities
yy Assess patient’s behavior in relation to age and life-stage norms
yy Evaluate patient’s socialization behaviors in relation to its home environment
yy Identify patient-specific behavioral abnormalities and causation
Veterinarian
4
Treatment plan for behavioral abnormalities
yy Develop integrated treatment plan that includes behavior modification, training of
alternative behaviors, and medication when appropriate
yy Prescribe appropriate pharmacologic intervention
yy Recommend client-administered non-pharmacologic interventions
yy Refer client to qualified animal trainer or behaviorist as needed
Veterinarian, technician,
assistant, other patient-care
personnel
5
Client education
yy Confirm that client recognizes the patient’s inappropriate behaviors and their causation
yy Demonstrate handling techniques and administration of medications
yy Provide oral and written instructions for client-administered intervention strategies
Veterinarian, technician,
assistant, other patient-care
personnel
6
Examination follow-up
yy Contact client about patient’s response to treatment plan, questions, and concerns
yy Schedule follow-up appointment as needed
Reception or other
client-service personnel
7
Re-examination evaluation of treatment response
yy Repeat steps 1–3
Reception personnel (initial
patient observation; provide
client with behavioral
assessment tool)
1
Technician, assistant, other
patient-care personnel
Technician, assistant, other
patient-care personnel
Veterinarian
8
Treatment plan modification or case resolution
yy Repeat steps 4 and 5
Veterinarian, technician,
assistant, other patient-care
personnel
21
Client Tools: General Behavior Questionnaires for Dogs and Cats
Ask clients to complete these forms at home or in the reception area for every visit. By targeting the main areas of concern,
these brief questionnaires help you direct conversations about the dog’s or cat’s behaviors. Ideally, a technician should review and
annotate the form before the exam begins.
This tool is not a substitute for a complete history that elicits detailed contextual information and behavioral patterns.
If it is used at all visits, however, patterns of behavior change can be recognized and addressed as they occur.
r
ur cat’s behavio
yo
t
u
___________
o
ab
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AAHA’s Resources on Behavior
These materials reflect the best judgment of their authors, which may or may not adhere to the
AAHA Guidelines in every detail. It is the prerogative and responsibility of each veterinary team to
determine whether these brochures best serve their practices’ protocols.
Low Stress Handling, Restraint and Behavior Modification of Dogs and Cats
Sophia Yin, DVM
With 1,600 photographs and 3 hours of video clips, this is the gold standard for
gentle handling, often credited with starting the movement toward a kinder, safer
office visit. Distributed by AAHA Press. http://bit.ly/1GB0vsw
First Steps with Puppies and Kittens: A Practice-Team Approach to Behavior
Linda White
2014 AAHA Weight Management
Guidelines for Dogs and Cats
How do you do it? Get the protocols, skills, and training that empower your team
to improve patients’ lives while boosting your bottom line. Accompanying CD
includes 45 sample handouts for clients on training principles and puppy and
kitten training tips on CD. http://bit.ly/1B9OojD
Obesity Is a Behavior Issue!
2014 AAHA Weight Management Guidelines for Dogs and Cats and Implementation Toolkit
IMPLEMENTATION
Common behavior issues impeding a pet’s weight loss, and their solutions, are
presented in Table 3 of these guidelines. Free download at http://bit.ly/1B6sheh
TOOLKIT
Busy Dogs
Pet Behavior Brochures
Wayne L. Hunthausen, DVM
Gary M. Landsberg, DVM, DACVB, Dip. ECVBM-CA
Don’t just tell your clients what’s going on with their pets. Send
them home with the information they need. AAHA’s behavior
brochures hit on the 18 most common problems clients face:
Basic Training: Teaching Your Puppy to Mind Its Manners
Busy Dogs Are Good Dogs
Crate Training: Creating a Canine Haven
Destructive Cats: Solving Chewing and Scratching Problems
Destructive Doggies: Solving Chewing and Digging Problems
Fearful Fido: Helping Your Dog Overcome the Fear of People
The Feisty Feline: Taming the Kitten with an Attitude
Litter Box Blues: Solving House-Soiling Problems
Noisy Canines: Solving Barking Problems
Piranha Puppies: Keeping Mouthing and Biting Under Control
Pushy Pups: Dealing with Unruly Young Dogs
Scaredy Cat: Helping Kittens and Cats with Fear
Senior Moments: Understanding Behavior Changes in Aging Pets
The Social Scene: Introducing Your Puppy to the World
Taking the Hassle Out of Housetraining Your Kitten
Taking the Hassle Out of Housetraining Your Puppy
Fido Was First: Training Your Dog for Baby’s Arrival
Home Alone: Solving Separation Anxiety Problems
Are
Good Dogs
Taking the
Hassle
out of
Housetraining
Your Kitty
Piranha
Puppies
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
Basic
Training
Noisy
Canines
Teaching Your Puppy
to Mind Her Manners
Creating Canine Heaven
Destructive
Doggies
Home
Alone
WeightMgmt_Booklet_final.indd 1
Keeping Mouthing
Solving Separation Anxiety Problems
and Biting Under Control
Scaredy
Cat
Helping Cats and Kittens with Fear
Crate
Training
Solving Barking Problems
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E RI ES
PE T B E HAV I OR B ROC HU RE SE RI ES
Social
Scene
Destructive
Cats
Senior
Moments
Introducing Your Puppy to the World
Solving Chewing
The
Understanding Behavior
Changes in Aging Pets
and Scratching Problems
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
PET BEHAVIOR BROCHURE SERIES
P E T B E HAV IO R B RO C HU R E S E R IES
BPDC2_PMS254.indd 1
Taking the
Hassle
out of
Housetraining
Your Puppy
P E T B E HAV IO R B RO C HU R E S E R IES
Litter Box
Blues
Solving Housesoiling Problems
Fido
Was
First
Training Your Dog for Baby’s Arrival
Pushy
Pups
Using the Power
1/23/14 9:15 AM
Solving Digging and Chewing Problems
PE T B E HAV I OR B ROC HU RE SE RI ES
10/9/14 10:45 AM
Fearful
Fido
Helping Your Dog Overcome
The
Feisty
Feline
Taming the Kitten with an Attitude
the Fear of People
of Positive Control
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E R IES
P E T B E HAV IO R B RO C HU R E S E RI ES
PE T B E HAV I OR B ROC HU RE SE RI ES
Take a closer look: Get a free sample pack of all
18 brochures at http://tinyurl.com/pgshmv6.
23
©istock.com/SVPhilon
This implementation toolkit was developed
by the American Animal Hospital Association
(AAHA) to provide information for
practitioners regarding each stage of a pet’s
life. The information contained in this toolkit
should not be construed as dictating an
exclusive protocol, course of treatment, or
procedure, nor is it intended to be an AAHA
standard of care. This implementation toolkit
is sponsored by a generous educational
grant from Ceva Animal Health, Virbac
Animal Health, and the AAHA Foundation.
About AAHA—
The American Animal
Hospital Association is an
international organization
of nearly 6,000 veterinary
care teams comprising more than 48,000
veterinary professionals committed to
excellence in companion animal care.
Established in 1933, AAHA is recognized
for its leadership in the profession, its high
standards for pet health care, and, most
important, its accreditation of companion
animal practices. For more information
about AAHA, visit aaha.org.
These guidelines were supported by a generous educational grant from
CEVA Animal Health, Virbac Animal Health, and the AAHA Foundation.
©2015 American Animal Hospital Association (aaha.org). All rights reserved. Front cover photo: ©istock.com/tankist276, back cover photo: ©istock.com/oztasbc